Form ID

Publication date

Location of premises

Certificate

Pool Roof Replacement

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Ontario Realty Corporation acting as agent on behalf of Her Majesty the Queen in right of Ontario as represented by the
Address of Owner
Vice President, Project Management Branch, Ontario Realty Co
Name of Contractor
Roque Roofing & Sheet Metal Ltd.
Address of Contractor
3 Clark Ave., Hamilton, ON L8L 5J7
Name of Certifier
IRC Building Sciences Group Inc.
Address of Certifier
2624 Dunwin Drive, Suite #4, Mississauga, ON L5L 3T5

Office to which claim for lien must be given to preserve lien

Chief Executive Officer, Ontario Realty Corporation, 77 Wellesley Street West, 11th Floor, Ferguson Block, Queens Park, Toronto, ON M7A 1N3